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421 Stimpson Dr Unit 102 Pellston MI 49769-8800 | |
(989) 736-8157 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 421 Stimpson Dr, Pellston, Michigan |
Authorized Official Name and Position | Christine Baumgardner (CEO) |
Authorized Official Contact | 9897368157 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 655 Alpena MI 49707-0655 Ph: () - | 421 Stimpson Dr Unit 102 Pellston MI 49769-8800 Ph: (989) 736-8157 |
NPI Number | 1174064869 |
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Provider Enumeration Date | 03/14/2017 |
Last Update Date | 10/25/2017 |
Medicare PECOS PAC ID | 5991691958 |
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Medicare Enrollment ID | O20170329001723 |
Identifier | Type | State | Issuer |
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1174064869 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |